Factors that influence the medication decision making of persons with HIV/AIDS: a taxonomic exploration.

It is well known that patients often alter their medication regimens and that these changes may have profound consequences for their health outcomes. Not so well known are the factors that influence the medication decision making of persons managing their own treatment in their day-to-day home situations. In this study, persons living with HIV/AIDS (PLWH) were asked about factors that affected the taking of their medications. Using semistructured interviews in this study of 57 PLWH, the authors used intensive analysis of the narratives to create taxonomies of the barriers and facilitators to taking HIV medications and the decisions that were involved. Categories of identified facilitators included motivation, factors of faith, routines, and others' influences. Categories of identified barriers included perceptions, psycho-emotional issues, provider/clinic issues, interpersonal factors, and disease and treatment factors. This study showed medication decision making to be a complex process, influenced by often-competing life and treatment issues and affected by participants' beliefs and values. These findings call for research into the everyday selfcare of PLWH to understand the reasoned decision-making that PLWH use in managing not only their medications but also their lives.

HIV/AIDS medication adherence factors: inner-city clinic patient's self-reports.

OBJECTIVE: To document common facilitators of, and barriers to, HIV/AIDS medication regimen adherence and to identify facilitators and barriers significantly correlated to attainment of higher vs. lower adherence. DESIGN: Data were collected using semi-structured interviews. SETTING: An outpatient clinic serving as the regional treatment center for HIV disease. PATIENTS: A purposive sample of 57 clinic patients was enrolled and completed the study. MAIN OUTCOME MEASURES: Self-reported adherence was measured using a visual analog scale and specified as higher or lower adherence at the 80% level, the approximate median. RESULTS: Many barriers to adherence were more prevalent in the lower adherence group, including complexity of the medication regimen and experiencing side effects. Lower adherence patients also had more problems with privacy and interference with social life and work or school. Patients in the higher adherence group were more concerned with forgetting as an adherence barrier. In general, social support, motivation to avoid AIDS, perceiving the health care practitioner as a facilitator, knowledge of medications, and keeping schedules were identified as factors enhancing adherence. CONCLUSIONS: The high prevalence of many barriers shows that the health care provider has an important role in patient education and support to accomplish increased adherence. Fear and avoidance behaviors in the lower adherence group contrasted with the increased concern with forgetting in the higher adherence group. Communicating treatment advances with patients may help more patients to address many barriers to higher adherence.

Application of feminist theory in nursing research: the case of women and cardiovascular disease.

Researchers have provided evidence that women recover from and live with heart disease in very distinct ways from men. The challenge for researchers has been to discuss women in a manner that allows their differences to emerge but does not depict them as inferior to men. Our goal is to review current cardiovascular research on women from a feminist theoretical perspective. We believe that a feminist perspective in cardiovascular research will advance the knowledge and recognition of women's health. We examined nine qualitative research articles in depth and applied a model of feminist research critique to them (Bunting, 1997). Historical androcentric notions in women's health and cardiovascular research are discussed. Also included are recommendations for future research to influence social change in women's cardiac health.